Exploring the Feasibility of a Peer-Driven Intervention to Improve HIV Prevention among Prisoners Who Inject Drugs

摘要概要： 东欧和中亚（EECA）是唯一一个艾滋病毒发病率和死亡率上升的地区， 注射毒品的人（PWID）经常与监狱接触。在吉尔吉斯斯坦（KYR）监狱中，阿片类注射者中的艾滋病毒流行率超过30%，在监狱内，药物注射与艾滋病毒阳性有关。KYR提供了一个独特的 有机会为监狱环境制定艾滋病毒预防计划，因为所有15个艾滋病毒预防计划 在监狱里，他们可以找到。根据全球监狱的许多共同点，KYR监狱的经验教训可以为其他国家的艾滋病毒预防工作提供信息，包括正在经历爆炸性阿片类药物的美国 疫情数据表明，注射毒品的囚犯可能会加入成瘾治疗计划，并受到同龄人的影响。 利用这些同伴对囚犯的影响，更有效地利用正规医疗服务，特别是 戒毒治疗方案和监狱内的注射器交换是世卫组织的一个优先事项。与专业外展相比 工作人员，同行驱动的干预措施（PDIs）在招募和参与艾滋病毒感染者方面更有效，更具成本效益 预防，但除了缺乏同伴教育监狱计划，PDIs没有涉及囚犯或直接关注 通过促进戒毒治疗或注射器交换减少艾滋病毒风险。为了解决这些关键差距，K 01奖将为候选人提供培训和指导，包括一项现实世界的双臂研究，重点是监狱中PWID的艾滋病毒初级预防。研究的第一个分支（项目1.1）开发，试点， 评估了为期12周的监狱PDI的可行性，以减少注射毒品的囚犯中的艾滋病毒风险， 现有的监狱戒毒项目研究的第二组（项目1.2）使用了12周PDI的人种学观察，以及实验组和对照组PDI后对研究参与者和监狱工作人员的定性访谈 监狱，探讨为什么PDI是成功的（或不），完善PDI手册，并制定假设归因于变化， 将在未来的R 01中进行测试以进行RCT的PDI结果。候选人罗扎诺娃博士 由于她强大的医学社会学和定性技能，将通过进一步培训扩展， 混合方法和生物统计学，以及她对艾滋病毒，成瘾和监狱健康的更高级培训的承诺， 两年前开始了新的职业生涯在5年内，她将实现她的职业目标：1）获得PDI开发和实施的经验，以解决监狱中艾滋病毒预防服务的特定耻辱障碍; 2）掌握使用民族志和定性访谈结合新的定量技能，从利益相关者的角度评估实验的成功，最终3）在以患者为导向的研究中发展独立的职业道路，重点是艾滋病毒预防，监狱和全球健康以及成瘾治疗。她将通过一个跨学科的导师团队实现她的目标，该团队具有艾滋病毒，成瘾，监狱健康，刑事司法环境实验和生物统计学方面的专业知识， 流行病学，并通过完成相关的教学工作和研讨会，并进行相关的研究，以应用技能 需要成为一个在耶鲁大学丰富的知识环境中的独立研究人员。

Abstract Summary: Eastern Europe and Central Asia (EECA) is the only region where HIV incidence and mortality has increased, primarily fueled by people who inject drugs (PWID) who interface regularly with prisons. In Kyrgyzstan’s (KYR) prisons, HIV prevalence among opioid injectors exceeds 30%, and within prison drug injection is associated with being HIV+. KYR presents a unique opportunity to develop an HIV prevention program for prison settings because all the 15 HIV prevention programs recommended for prisons are available there. Based on many commonalities shared by prisons globally, lessons learned in the KYR prisons can inform HIV prevention efforts in other countries, including the US that is experiencing an explosive opioid epidemic. Data suggests that prisoners who inject drugs may join addiction treatment programs, and influenced by peers. Harnessing these peer influences on prisoners to incorporate more effective use of formal healthcare services, especially of addiction treatment programs and syringe exchange within prison, is a WHO priority. Compared to professional outreach workers, peer-driven interventions (PDIs) are more efficient and cost-effective in recruiting and engaging PWID in HIV prevention, yet aside from scant peer education prison programs, PDIs have not involved prisoners or directly focused on reducing HIV risk through promoting engagement with addiction treatment or syringe exchange. To address these critical gaps, the mentored K01 Award will provide the candidate with training and mentoring, including a real-world two-arm study that focuses on primary HIV prevention among PWID in prisons. The first arm of the study (Project 1.1) develops, pilots, and assesses the feasibility of a 12-week in-prison PDI to reduce HIV risk among prisoners who inject drugs by increasing uptake of available prison addiction treatment programs. The study’s second arm (Project 1.2) uses ethnographic observation of the 12-week PDI, and qualitative interviews with study participants and prison staff after the PDI in both Experiment and Control prisons, to explore why the PDI is successful (or not), refine the PDI manual, and develop hypotheses attributing changes in outcomes to the PDI that will be tested within a future R01 to conduct a RCT. The candidate, Dr. Rozanova, is well-positioned to perform this work because of her strong medical sociology and qualitative skills that will be extended by further training in mixed-methods and biostatistics, and her commitment to more advanced training in HIV, addiction, and prison health after transitioning her career to the new field 2 years ago. Over 5 years, she will achieve her career goals to: 1) Gain experience in PDI development and implementation to address stigma-specific barriers to HIV prevention services in prison; 2) Master using ethnography and qualitative interviews combined with new quantitative skills to evaluate the success of an experiment from its stakeholders’ perspective, and ultimately 3) develop an independent career path in patient-oriented research focused on HIV prevention, prison and global health, and addiction treatment. She will achieve her goals from an interdisciplinary team of mentors with expertise in HIV, addiction, prison health, experiments in criminal justice settings, and biostatistics and epidemiology, and through completion of relevant didactic work and seminars and conduct related research to apply the skills needed to become an independent researcher within the rich intellectual environment available at Yale University.